Implantable cardioverter defibrillator for primary prevention in patients with severe ventricular dysfunction awaiting heart transplantation

摘要

Background Despite an increase in patients with end-stage heart failure, the acceptance rate has been going down in recent years owing to a change in donor demographics. Furthermore, the rate of emergency heart transplantation has progressively increased. The result is an increase in the time awaiting heart transplantation in elective patients and therefore in the risk of sudden death in this population. Implantable cardioverter defibrillators (ICDs) could be a preventive option in these cases. However, indications for the implantation in this population are not well established. Objective We sought to evaluate the effectiveness of ICDs for primary prevention in patients with left ventricular ejection fraction (LVEF) ≤30% included on the heart transplantation list. Methods Records from patients accepted for heart transplantation in our institution from January 1, 2006, to July 30, 2012, and whose LVEF was 31% were reviewed. Patients who received ICDs for primary prevention (n = 28) were compared with patients without ICDs (n = 51). Descriptive and univariate (χ2 and t tests) statistics and Kaplan-Meier survival curves were used for analyses. Results With a median follow-up of 77 days (range 1-1,231), the overall mortality in the ICD group was 7.1% (2/28) and in the non-ICD group was 17.6% (9/51; P =.062). The main cause of death in patients without ICDs was sudden death (5/9, 55.6%), followed by heart failure (4/9, 44.4%). In patients with ICDs, heart failure was the only reported cause of death. Appropriate ICD therapies were recorded in 42.9% (12/28) in this population. Conclusions This study suggests that ICD could reduce the risk of sudden death in patients with LVEF ≤30% while awaiting heart transplantation. However, more studies are needed to confirm these results.